01.07 Growth & Development – School Age-Adolescent

Hey and Welcome! We are going to go over what to expect for school age kids and adolescents. So major milestones and the important things that are happening here are really shifting from skills to social and cognitive experiences. There honestly isn’t much to say about motor and an language kids should just be trucking along with those. So, let’s get started!

School age kids are curious and generally love to understand what is happening to their bodies while in hospital.

During the school age phase the arms and legs grow a lot. Usually kids are growing about 2 inches per year and gain 5-7 lbs/year. Brain growth is also complete during this time by around ages 9 and 10. Puberty may also start in the later years.

This age group is pretty motivated. Erikson gives this the term industry. School age kids are learning to read, write, do math and move to independence. Cognitively, they are able to process things in a more complex, less black and white way. They love understanding processes and appreciate being given the facts. This is important as you consider prepping this age group for any kind of procedure in the hospital. This age group can smell crap from a mile away! So, with the parents help I recommend speaking very plainly and accurately.

Cognitively one, of the great things that happens during this age range is that they can process and understand pain a little better. They still have a tough time describing pain but when it comes to procedures they can understand that it’s temporary. So usually around 5 or 6 we no longer have to hold down and restrain during procedures! This is awesome because it means that you can now put in an IV without also feeling like you also got a total body workout.

A couple of potential health problems that may come up during this age are Enuresis, or bedwetting and behavioural problems like ADHD. Both of these diagnoses are covered in their own individual lessons so check those out!

Stress starts to enter the picture at this age because they are experiencing outside pressures for the first time. So you may see things like headaches and stomach aches occur, related to an upcoming performance or stressful event.

Okay guys - let’s move onto our last age group! Adolescents are ages 13-18 years and after the relative developmental stability of preschool and school age years - adolescence can pack a pretty big punch.

The most important element of growth happening during these years are related to puberty. The age ranges for onset of puberty are pretty wide so like I said before, some will have started showing signs of puberty during the school-age years. The Tanner Stages are used to classify the different stages of puberty and the outline for this lesson covers some important terms and also a bit more about the expected sequence of puberty for males and females.

Okay, so socially and cognitively - teenagers are developing rapidly. Their primary goal is to find their own identity and peer groups are the most important factor influencing this. It can be a pretty stressful phase with all the physical changes and emotions that go along with becoming an adult. Add to this the fact that they have a tendency to view things with the short game in mind - meaning they have that perspective that nothing bad can ever happen to them. And you’ve got a high risk phase of development.

Because of this it’s is super important to ask questions about their environment and also their social and mental well being. When talking to teens use the HEADSS assessment as a guide. It stands for Home, Education, Activities, Drugs, Sexuality, Suicide. Use open ended questions and always give teens the opportunity to speak to you without their parents present.

Oh yeah, before we move on, in your Fundamentals course there’s an entire lesson on risky behaviours so check that out!

So, our important topics to consider for teenagers are 1) reproductive health 2) mental health 3) healthy lifestyle and 4) Transitioning to adult medical care.

Reproductive health is obviously super important and covers topics like contraception, STI’s and general sex education. Check out the OB lesson on Family Planning for more on this.

Mental health requires a lot of attention for teens and there’s a lot of research out there now that suggests that teens are under a lot of stress and that in some ways it’s kind of new and different than other generations have experienced. Suicide rates in teens went up 10% from 2015-16 and that’s on top of an 84% increase from the years 2007 - 2015. Those are scary statistics and just highlight how important it is to pay attention to any signs of psychological distress you may come across in your teenage patients.

Educating our teens on how to just live a generally healthy life is super important also because these guys are about to be out on their own making their own decisions. Obesity has become more and more a problem for children and adolescents so that needs to be on our radars for patient education.

Last but not least - teenagers with chronic illnesses need to be prepped for transitioning to adult care. It can be a bit of a scary move to go from the cozy colourful peds unit to an adult ward. Nursing care needs to focus on involving them in planning their care. Two diagnosis that this is particularly important for are cystic fibrosis and sickle cell disease.

Okay! That’s a wrap for this development session. Your nursing concept for this one and all the other ones as well are human development, patient centered care and health promotion.
Okay guys! Key points to take away from this lesson. The first two are specific to our school age kids. Remember it is a relatively peaceful time stuck between the intense first 5 years and then the intense years of adolescence. So potentially less going on- fewer developmental issues. The ones that do come up tend to be around behavioural or social problems so thinking about diagnosis like Autism and ADHD. For our adolescents, make sure you are familiar with the key terms related to the sequences of physical development for males and females. Be familiar with the HEADSS assessment and how to help teens navigate around those risky behaviours. And lastly, we have to help our teens be ready to go into the adult world! So nursing care takes on the additional goal of encouraging autonomy and independence with all aspects of their health.

That’s it for our lesson on growth and development during school age and adolescence. Make sure you checkout all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!